QuestionIn the treatment of health anxiety, can internet-delivered cognitive behavior therapy lead to comparable effects as conventional face-to-face cognitive behavior therapy while using less resources?

FindingsThis randomized noninferiority clinical trial in a primary care setting included 204 adults with a principal diagnosis of health anxiety. Internet-delivered cognitive behavior therapy was found to be noninferior to face-to-face cognitive behavior therapy while generating lower net societal costs.

MeaningAs internet-delivered cognitive behavior therapy is not inferior to face-to-face cognitive behavior therapy and requires little resources, the online treatment format should be considered a first-line intervention for health anxiety.

Abstract

ImportanceHealth anxiety is a common and often chronic mental health problem associated with distress, substantial costs, and frequent attendance throughout the health care system. Face-to-face cognitive behavior therapy (CBT) is the criterion standard treatment, but access is limited.

ObjectiveTo test the hypothesis that internet-delivered CBT, which requires relatively little resources, is noninferior to face-to-face CBT in the treatment of health anxiety.

Design, Setting, and ParticipantsThis randomized noninferiority clinical trial with health economic analysis was based at a primary care clinic and included patients with a principal diagnosis of health anxiety who were self-referred or referred from routine care. Recruitment began in December 10, 2014, and the last treatment ended on July 23, 2017. Follow-up data were collected up to 12 months after treatment. Analysis began October 2017 and ended March 2020.

InterventionsPatients were randomized (1:1) to 12 weeks of internet-delivered CBT or to individual face-to-face CBT.

Main Outcomes and MeasuresChange in health anxiety symptoms from baseline to week 12. Analyses were conducted from intention-to-treat and per-protocol (completers only) perspectives, using the noninferiority margin of 2.25 points on the Health Anxiety Inventory, which has a theoretical range of 0 to 54.

Conclusions and RelevanceIn this trial, internet-delivered CBT appeared to be noninferior to face-to-face CBT for health anxiety, while incurring lower net societal costs. The online treatment format has potential to increase access to evidence-based treatment for health anxiety.